The field of the invention is specially designed instruments and methods for cardiac surgery using a transxyphoid incision.
Prior techniques to reduce the trauma and expense of cardiac surgery include closed chest procedures using specially configured catheter-based apparatus to achieve cardiopulmonary bypass (CPB) combined with less invasive port-access type incision and special techniques and apparatus to eliminate CPB by employing a minimally invasive surgical technique and performance at the surgical procedure on the beating heart. These existing closed chest procedures eliminate the trauma associated with an open chest incision but still have the drawbacks associated with CPB. The existing beating heart procedures avoid CPB but still typically require a transthoracic incision, i.e., an incision that penetrates the rib cage in some fashion. Thus, while these approaches provide a less invasive procedure compared to the traditional medial sternotomy or thoracotomy, any procedure that traverses the ribs or sternum may cause complications and may slow the post-operative recovery of the patient.
The several inventions described here are devices and methods to facilitate minimally invasive cardiac surgery on the beating heart using an incision in the xyphoid region to provide access to the beating heart. The methodology of the invention enables a beating heart coronary artery bypass graft (CABG) procedure without a port-access or other incision that penetrates the rib cage. The use of a surgical retractor to spread the ribs apart from one another is avoided thus the possibility of broken ribs and the possible necessity of remaining portions of ribs is eliminated.
Moreover, typically the pleura remains intact, a result that speeds recovery and guards potential complications. The devices of the incision are specially designed to facilitate the xyphoid incision approach and avoid CPB by enabling the surgery to be performed on the beating heart. The devices of the invention include, individually and in combination, a specialized retractor to facilitate access to the beating heart through the xyphoid incision, or beating-heart stabilizer, and other complementary surgical instruments.
Specifically, the invention includes a retractor or access platform designed to provide the function of a vertical offset of the lower sternum and preferably further comprising attachments to affix complementary surgical instruments, including at least a stabilizer for the beating heart. Generally, the stabilizers are of the type disclosed in PCT Application US 96/15091 (WO/10753), EPO Application 97/02789.1, and U.S. Pat. No. 5,727,569. The specially designed retractors described herein may also incorporate lights, blowers, suction or other conventional apparatus to facilitate surgical procedure.